Provider Demographics
NPI:1891396974
Name:KERCHER, KIMBERLY DEANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DEANN
Last Name:KERCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E PEMBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3456
Mailing Address - Country:US
Mailing Address - Phone:316-204-3831
Mailing Address - Fax:
Practice Address - Street 1:LEGACY AT GRASSLAND ESTATES
Practice Address - Street 2:10665 W 13TH ST N APT 329
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-204-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist